In many Indian centres, a woman with a bulky Stage IB2 squamous carcinoma of the cervix who is otherwise fit for surgery may be offered platinum-based neoadjuvant chemotherapy followed by radical hysterectomy. The principal rationale for this approach is:

• A Superior survival compared with primary concurrent chemoradiation demonstrated across all randomised trials
• B Complete replacement of postoperative radiotherapy in all responding patients regardless of final histology
• C Tumour downsizing and elimination of microscopic parametrial and nodal disease before definitive surgery ✓
• D Avoidance of any need for lymph node assessment since chemotherapy sterilises nodal disease

Explanation

Neoadjuvant chemotherapy uses cisplatin-based regimens to shrink bulky early tumours, improve operability and reduce positive nodes, margins and parametrial involvement before radical hysterectomy. It is accepted practice in several low-resource settings, including India, where radiotherapy access is constrained, though trials have not shown clear superiority over primary concurrent chemoradiation. Postoperative pathological risk factors may still mandate adjuvant therapy, and surgical nodal assessment remains essential.

Reference: Berek & Hacker's Gynecologic Oncology, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.